sociology of health and illness exam three

cultural competence what is it?

"combines the tenets of patient/family- centered care with an understanding of the social and cultural influences that affect the quality of medical services and treatment" "describes the ability to provide care to patients with diverse values, beliefs, and behaviors, including tailoring health care delivery to meet patients' social, cultural, and linguistic needs" having health care providers who are aware of other cultures leads to a more positive, patient/ provider outcome

paternalistic model

"parental" or "priestly model" -in this model the physician patient interaction ensures that patients receive the interventions that best promote their health and well being to this end physicians use their skills to determine the patients medical condition, and his or her stage in the disease process and to identify the medical tests and treatments most likely to restore the patient's health or ameliorate the pain. then the physician presents the patient with selected info that will encourage the patient to consent to the intervention the physician considers best at the extreme the physician authoritatively informs the patient when the intervention will be initiated this model assumes that there are shared objective criteria for determining what is best. the physician can discern what is the patients best interest with limited patient participation. ultimately it is assumed that the patient will be thankful for decisions made by the physician even if he or she would not agree to them at the time.

cultural competence what does it do

"published research suggest cultural competence may improve physician patient communication and collaboration, increase patient satisfaction and enhance adherence, thereby improving clinical outcomes and reducing health disparities" "among health professionals is viewed as one strategy to ensure equal access to healthcare across diverse groups and to ensure that patients receive care by their needs. however many physicians are insufficiently prepared to meet the needs of increasingly diverse populations challenges that first nations, inuit and metis face in the medical system. intended to be a starting point for conversation about the increased need of cultural safety and sensitivity

informative model pt 1

"scientific engineering or consumer model" objective of the physician patient interaction is for the physician to provide the patient with all relevant information for the patient to select the medical interventions to this end. the physician informs the patient of his or her disease state, the nature of possible diagnostic and therapeutic interventions, the nature and probability of risks and benefits associated with the interventions and any uncertainties of knowledge. at the extreme, patients could come to know all medical information relevant to their disease and available interventions and select the interventions that best realize their values.

major barriers to communication:

- differences in status, education, professional training, authority and power (doctor vs. patient) doctors use of medical terms, lack of understanding by patient evasion- answer to patients questions are evasive because the doctor doesnt think the patient can understand them or they are uncomfortable explaining what it may be, technically unintelligable answers:jargin, medical framework unequal: communication as a therapeutic tool

models of interaction hayes-bautista 1976

- focuses on how patients modify a physicians prescribed treatment -interaction viewed as a process of negotiation -limited to situations in which the patient is dissatisfied - in non-emergency situations, patients are not necessarily passive -patients try to modify the treatment prescribed by a physician. physicians respond by pointing out their expertise (your health will be threatened if treatment is not followed properly/ treatment is correct, detective, negotiator, salesperson, etc. to induce patient adherence)

engineering model

- in this model, health care professional is a specialized master. the healthcare professional shows the realities to the patient without making any esteem judgement. the patient settles on an official choice. - the physician assumes medicine to be a value-free enterprise whose primary task is the presentation of all relevant facts to the patient without involvement in actual decision making. vaetch sees this model as impractical and wrong in excluding physician involvement with ethical concerns

business benefits of cultural competence

- incorporates different perspectives, ideas, and strategies into the decision making process -decrease barriers that slow progress -moves toward meeting legal and regulatory guidelines -improves efficiency of care services -increases the market share of the organization

social benefits of cultural competence

- increases mutual respect and understanding between patient and organization -increases trust -promotes inclusion of all community members -increases community participation and involvement in health issues -assists patients and families in their care -promotes patient and family responsibilities

models of interaction veatch 1991

-based on values of doctors and patients -engineering model -priestly model -collegial model -contractual model

team oriented

-clergy and hospice -less physician authority -social worker, case manager involved- discharge planning etc. -health outcomes improve

mutual participation

-doctor helps patient help themselves -equalitarian -acknowledge that patient must be a central player -assuming a competent, educated adult patient

guidance cooperation model

-doctor tells patient what to do to get better -typical of most medical encounters -patient alarmed by medical problem- has certain hopes and aspirations for the outcome -increased involvement in providing info -physician is still in charge but seeks the cooperation of the patient -similar to parent-adolescent relationship

decline in professional power

-early 21st century: profession in decline in terms of power -lights countervailing power thesis -most impact from external sources -government regulation -managed core -corporate health care -changing physician patient relationship also impacted by -decline in public trust in doctors, medicine, and science in general, rise of internet and social media

health care professions:

-healthcare occupations are projected to add more jobs than any of the other occupational groups -according to the association of schools of allied health professions: -nearly 60 percent of health care workforce is in the allied health professions. Defined as : "the segment of the workforce that delivers services involving the identification, evaluation and prevention of diseases and disorders; dietary and nutrition services; and rehabilitation and health systems management"

professionalization

-important role for the american medical association (AMA) -status continued improving through the 20th century - became an occupation high in wealth, power and prestige -had great public trust -mid-20th century "golden age" of doctoring -friedsons professional dominance theory

health benefits of cultural competence

-improves patient data collection -increases preventative care by patients -reduces care disparities in the patient population -increases cost savings from a reduction in medical errors, number of treatments, and legal costs -reduces the number of missed medical visits

becoming a doctor

-long, difficult, and expensive process to become a physician -medical students go through a socialization process 1st year: idealism and uncertainty 2nd year: similar to first, less anxiety 3rd and 4th year: clinical work hidden curriculum

interaction and communication

-major barriers to effective communication between doctors and patients -common form of communication (by doctor) evasion -more emphasis on communication in medical schools now -recognized as potentially an important therapeutic tool -medical treatment begins with dialogue between physician and patient: how to be positive: respect, cooperation, mutual understanding -health care applies to this as well, relies on what kind of care you receive

patients and physicians: the medical decision rule

-patient distress may not be only physical, (psychological) -quality of interaction can be problematic, potential to affect care -general trend towards greater equality in decision-making with mutual participation as standard in interactions -exceptions exist

history of the american physician

-prior to the early 20th century, medical education was low quality and being a doctor held low prestige -changes with the flexner report of 1910 -emphasis on medical science, standardization -status of physicians improved

cultural competence strategies

-some common strategies for improving the patient-provider interaction and institutionalizing changes in the health care system include: - provide interpreter services -recruit and retain minority staff -provide training to increase cultural awareness, knowledge, and skills -coordinate with traditional healers -use community health workers -incorporate culture-specific attitudes and values into health promotion tools -include family and community members in health care decision making -locate clinics in geography areas that are easily accessible for certain populations -expand hours of operation - provide linguistic competency that extends beyond the clinical encounter to the appointment desk, advice lines, medical billing and other written materials

physician and other health care occupations

-work of other occupations that do patient care is still primarily organized around the work of the physician -usually under direct supervision -why subordinate roles: -technical knowledge is used physician approved -they assist doctor, not replace -work occurs at the request of the doctor (doctor's orders) -physicians have the most privilege -relations between physicians and health care administrators -its complicated (cost of administrative services are more than services itself, more business operations= more administrators) -medical and health services management -physicians control, orders, ultimate power, authority, responsibility for patient care

interpretive model

aim of patient- physician interaction to elucidate the patients values and what he or she actually wants and to help the patient select the available medical interventions that realize these values physician provides the patient with information on the nature of the condition and the risks and benefits of the possible interventions. interpretive physician assists the patient in elucidating and articulating his or her values and in determining what medical interventions best realize the specified values. thus helping to interpret the patients values for the patient. the patients values are not necessarily fixed and known to the patient, often inchoate and the patient may only partially understand them, they may conflict when applied to specific situations patient must elucidate and make coherent these values -physician works with the patient to reconstruct the patients goals and aspirations commitments and character at the extreme- the physician must conceive the patients life as a narrative whole, and from this specify the patients values and their priority determines which tests and treatments best realize these values -physician does not dictate to the patient it is the patient who ultimately describes which values and course of action best fit who she or he is neither is the physician judging the patients values; helps patient to understand them in the medical situation, physician is a counselor

professionalization 1900

american journal of nursing -nursing school growth occurred through late 19th and early 20th centuries (florence nightingale) -gender issues -affected by educational process and position relative to physician (time, requirement, training etc.)

models of interaction emanuel and emanuel 1992

consider differences in information providing and relationship with patient -paternalistic model -informative model - interpretive model -deliberative model

current realities

current issues for medicine -changes over time in conceptualization of medicine and medical practice e.g. telehealth -there are also the realities for the individuals who become physicians and what that means for their personal lives e.g. career mobility, routines

deliberative model

doesnt go beyond professional relationship -aim to help the patient determine and choose the best health related values that can be realized in the clinical situation moral deliberation: physician must delineate information on the patients clinical situation and then help elucidate the types of values embodied in the available options objectives include: suggesting why certain health related values are more worthy and should be aspired to at the extreme: physicians and patient engage in deliberation about what kind of health related values the patient could and ultimately should pursue discusses only health related issues aims at no more than moral persuasion. coercion avoided

cultural competence why do it

has emerged as an important issue in healthcare - diversity of patients - patient-provider communication linked to satisfaction, compliance, and health outcomes -improves quality of care and reduces/eliminates (racial ethnic and other health care disparities) being sensitive to diversity, reach patient at who they are.

future issues and challenges

image ( of nursing ) professional status and changing roles shortage and aging of workplace -increased need attracting recruiting end shortages, pay benefits etc recruitment and retaining

paternalistic model

in the tension between the patient's autonomy and well-being, between choice and health, the paternalistic physicians main emphasis is towards the later in this model the physician acts as the patients guardian. articulating and implementing what is best for the patient. as such, the physician has obligations, including that of placing the patents interest above his or her own and soliciting the views of others when lacking adequate knowledge. the conception of patient autonomy is patient assent, either at the time or later, to the physicians determinations of what is best

nursing in the us

largest single group of health care workers in the us

doctor-patient interaction

medical decision rule (friedson), guiding principle

parson's concept of the sick role: guidelines for patient-doctor relation

obligations toward eachother: patient: cooperate with doctor doctor: return to functioning normalcy -physicians have a bias favor in finding illness in their patient. Because patient's expect it and the physicians want to meet those expectations

cultural competence moving forward

organizational, systematic and clinical facets of health care are central to advancing cultural competence -ongoing learning process

medical decision rule, meeting the needs:

patient distress- uncertainty psychological worries relations- not always working under same understandings

activity passivity model

patient seriously ill -doctor does something to the patient -similar to asymmetrical rel. of the parsonian model -physician represents the medical expertise. controls communication flow between the physician and patient, makes the important decisions, patient relies on the physician for knowledge -similar to parent- infant relationship

focus on nurses: largest group

projected increased need for health care and health care workers profession: providing comprehensive, patient centered care -daily functioning -exercise and physical movement -nutrition -speech -health education graduate work about four million people employed non physician health care task

physician nurse relationships

stein 1967- interactional style used in physician- nurse relationships: the doctor nurse game (objectives rules informal scores) - a revisiting of this in 1990 suggested a different situation -gender issues still relevant -holyoake 2011 argues that the game goes on and is still being played today -2 groups misunderstood/misunderstand eachothers role -nursing is attempts to be like medicine powerful women nurses vs. powerful men profession physician nurse recommendation without being obvious and physician must ask for them in same way -dont disagree nurses not willing to be treated like subordinates always aiming for approval doctors looking for cooperation nurses more dissatisfied emulate medical knowledge to improve status caring different from medicine complementary different roles

RNS responsible for

the nature and quality of all nursing care that patients receive, but also for following the instructions for physicians regarding the patients they additionally supervise practical nurses and other health personnel involved with patient care (supervise, coordinate, provide care) shortage in the 1980s questions of professional status: gender: male nurse

medical decision rule

the notion that since the work of the physicians tend to impute (assign) illness to their patients rather than to deny it and risk overlooking or missing it. this approach may promote tendencies to prescribe drugs and order laboratory tests and x-rays: such consequences should not be surprising. (patients desire and demand services, and physicians are trained to meet these demands.) "while the physicians job is to make decisions, including the decision not to do anything, the fact seems to be that the everyday practitioner feels impelled to do something when the patients are in distress"

contractual model

the physician and patient interact with the understanding that there are obligations and expected benefits for both parties though no necessary mutuality of interest

collegial model

the physician and patient see themselves as colleagues pursuing a common goal of restoring the patient to good health. vaetch likes this model but perceives it to be unrealistic due to ethnicity, class, and value differences between physician and patient

priestly model

the physician is viewing as quasi-religious figure who is an "expert" on ethical and all other matters that emerge in a relationship. vaetch opposes this because the patients individual autonomy is erased

health care professionals

there is a wide range of health care personnel -athletic trainers -audiologists -chiropractors etc.

informative model pt 2

this model assumes a fairly clear distinction between facts and values. the patients values are well defined and known; what the patient lacts is facts. it is the physicians obligation to provide all the available facts and the patients values then determine what treatments are to be given there is no role for the physicians values, the physicians understanding of the patients values or his or her judgement of the worth of the patients values the physician is a purveryor of technical expertise, providing the patient with the means to exercise control as technical experts, physicians have important obligations to provide truthful information, to maintain competence in their area of expertise, and to consult others when their knowledge or skills are lacking. the conception of patient autonomy is patient control over medical decision making

models of interaction (szasz and hollender) 1956

type of interaction depends on the severity of the patients symptoms -activity passivity model -guidance cooperation model -mutual participation model -they argued that parsons gave too little attention to the influence of psychological symptoms

cultural competence

various benefits to patients providers and organizations

relevance of hayes-bautista

view of interaction as a process of negotiation rather than the physician simply giving orders and the patient is following them in an automatic, unquestioning manner